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IOSR Journal of Nursing and Health Science (IOSR-JNHS)
e-ISSN: 2320–1959.p- ISSN: 2320–1940 Volume 4, Issue 1 Ver. III (Jan.-Feb. 2015), PP 40-43
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A Study to determine the effectiveness of honey /frozen fruit
juice/fresh fruit juice along with oral Care protocol in reducing
chemotherapy induced Oral mucositis among oncology clients in
Devaki Hospital at Madurai.
M. Jasline
I.
Introduction:
In most people’s minds there is no scarier diagnosis than that of cancer. Cancer is often thought of
untreatable, unbearably painful disease with no cure. Cancer may be popular and over generated. Cancer is
undoubtedly a serious and potentially life threatening illness. It is the leading cases of death in older Americans,
1.5 million new cases of cancer occurring in United State coming year and over 570,000 deaths in another two
million cases per year. It is misconception to think that all from of cancer’s which are not reported but could add
another truth of the matter is that there are multiple type of cancer, many of which can today be effectively
Treated so as to eliminate, reduce or slow the impact of the disease on patients’ lives, while a diagnosis of
cancer may still leave patients’ feeling helpless and out of control, in many cases today there is cause for hope
rather than hopelessness.
Chemotherapy is a type of cancer treatment that uses drugs to destroy cancer Cells. Chemotherapy
works by stopping or slowing the growth of cancer cell, which grow and divide quickly. But it can also harm
healthy cells that divide quickly, such as those that line in mouth and intestines. Damage to healthy cells may
cause side effects. When chemotherapy destroyed cancer cells to the point that can no longer detect them in our
body and they will not grew back, prevent from spreading, slow it growth or destroys cancer cells that have
spread to other parts of the body. Chemotherapy often results in Erythema, edema, atrophy and ulceration of
the oral mucosa, a condition generally referred to as oral mucositis. When the oral mucosa becomes atrophic
from chemotherapy, local trauma leads to ulceration, with nonkeratinized sites in the mouth, namely the buccal
mucosa, the ventral and lateral parts of then tongue, the labial mucosa, the floor of the mouth, the soft palate,
and the oropharyngeal fauces.
Oral mucositis may progress to painful ulcers and infection, interfering with eating, talking, and taste,
chewing or swallowing and often lasting 7-14 days.
Nature is the important source for producing new medicines. Honey is the by product of flower nectar.
This natural product has antibacterial properties and enhances epithelization of the mucosa, and is thereby a
justified approach in the management of mucositis.
Papaya is a wonderful fresh fruit and its healing properties. It contains proteolytic enzymes papain.
Papain is also being studied for relief of cancer therapy side effects, especially relieving side effects such as
difficulty swallowing and mouth sores after radiation and chemotherapy as well as boosting up the immune
system and helping body to fight the cancer.
Recently a randomized controlled trial compared the efficacy of topical pure honey to usual medical
care in 40 patients with cancer in the head and nech. In this preliminary study, honey group experienced
significant reduction in grade 3 and grade 4 mucositis.
An interesting Egyptian study shows honey being effective against oral mucositis. In the treatment
group, no patients development grad 4 mucositis and only the 3 patients (155) Developed grade 3 mucositis. In
the control group,13 patients (65%) developed grade 3 or 4 mucositis.
II.
1.
2.
3.
4.
5.
Objectives
To assess the existing level of oral mucositis among oncology clients undergoing chemotherapy.
To find out the effectiveness of application honey along with oral care protocol among group-I oncology
clients.
To find out the effectiveness of swish and swallow frozen fruit juice along with oral care protocol among
group-II oncology clients.
To fine out the effectiveness of application of fresh fruit juice along with oral care protocol among groupIII oncology clients.
To compare the effectiveness of honey/frozed fruit / fresh fruit juice in reducing oral mucositis among
group –I and Group-II & group –III oncology clients.
DOI: 10.9790/1959-04134043
www.iosrjournals.org
40 | Page
A Study to determine the effectiveness of honey /frozen fruit juice/fresh fruit juice along with oral ….
6.
To find out the association between level of oral mucositis among group-I, group II and group III oncology
clients and their selected demographic variables.
Hypothesis:
1. There will be a significant reduction in the level of oral mucositis among group –I oncology clients after
applying honey.
2. There will be a significant reduction in the level of oral mucositis among Group-II oncology clients after
giving frozen fruit juice.
3. There will be a significant reduction in the level of oral mucositis among Group-III oncology client after
applying fresh fruit juice.
4. There will be a significant difference in the reducation in the level of oral mucositis among Group-I and
Group-III oncology clients.
5. There will be a significant association between level of oral mucositis among Group-I, group II and group
III oncology clients and their selected demographic variables.
III.
Materials and methods
Research approach and design:
The research design selected for this study is quasi experimental research design with three experimental group.
Group-I
Group-II
Group-III
O1
O1
O1
X1
X2
X3
O2
O2
O2
Group-I: - experimental group with honey application
Group-II: - experimental group with swish and swallow of frozen fruit juice.
Group-III: - experimental group with application of fresh fruit juice.
O1 : Pretest
X1 : application of honey
X2 : swish and swallow of frozen fruit juice
X3 : application of fresh fruit juice
O2 : post test
Setting of the study:
The study was conducted at Devaki cancer research institute (Hospital) at Madurai. The population of
the study was the clients with cancer who received chemotherapy and having oral mucositis. 45 clients were
selected as the sample using purposive sampling technique.
Research tool and consist of the demographic data and a Standardized Oral assessment guide-oral
mucositis. data analysis was carried out by using descriptive and inferential statistics (ANOVA).
Data collection procedure:
45 chemotherapy clients with moderate to severe oral mucositis were selected as study subjects and
divided into three groups. A pre intervention test is carried out to assess the level of mucositis. Honey, fresh fruit
juice and frozen fruit juice were administered to Group I, Group II and group III respectively. Intervention will
be given for groups two times a day up to one month.
Post test was conducted 6 month after the intervention.
IV.
Results and analysis
Section I: GROUP I Pre intervention Level of Mucositis
N=15
Level of Mucositis
Category
Mild
Moderate
Severe
Total
9 – 13
14 – 18
19 - 24
Respondents
Number
0
07
08
15
Percent
0
46.67
53.33
100.0
The above table indicates the pre-intervention level of mucositis in group 1 cancer patients before administering
Honey. Most of the patients 8 (53.33) are having severe mucositis and 7(46.67) are having moderate level of
mucositis.
DOI: 10.9790/1959-04134043
www.iosrjournals.org
41 | Page
A Study to determine the effectiveness of honey /frozen fruit juice/fresh fruit juice along with oral ….
Post intervention Level of Mucositis
N=15
Level of Mucositis
Category
Mild
Moderate
Severe
Total
9 – 13
14 – 18
19 - 24
Respondents
Number
13
2
0
15
Percent
86.67
13.33
0
100.0
The above table indicates the post-intervention level of mucositis in group 1 cancer patients after
administering honey. Most of the patients 13(86.67) are having mild mucositis and 2(13.33) are having
moderate mucositis. No patient is having severe level of mucositis.
Comparison of Overall Pre test and Post test Mean level of mucositis
N=15
Aspects
Paired ‘t’ Test
Respondents level of mucositis
Mean
SD
18.867
2.899
10.4
1.6818
8.467
Pre test
Post test-2
Enhancement
9.7816*
* Significant at 0.05 level,
The t-test value (t=9.7816) indicates that there is a significant difference (improvement) in the pre and post
intervention level of patient condition (oral mucositis).
Section - 2: GROUP II Pre intervention Level of Mucositis
N=15
Level of Mucositis
Category
Mild
Moderate
Severe
Total
9 – 13
14 – 18
19 - 24
Respondents
Number
0
06
09
15
Percent
0
40
60
100.0
The above table indicates the pre-intervention level of mucositis in group 2 cancer patients before administering
fresh fruit juice (papaya). Most of the patients 9 (60) are having severe mucositis and 6(40) are having moderate
level of mucositis.
Post intervention Level of Mucositis
N=15
Level of Mucositis
Category
Mild
Moderate
Severe
Total
9 – 13
14 – 18
19 - 24
Respondents
Number
11
4
0
15
Percent
73.33
26.67
0
100.0
Table-11 indicates the post-intervention (post test 2) level of mucositis in group 2 cancer patients after
administering fresh fruit juice (papaya). Most of the patients 11(73.33) are having mild mucositis and 4(26.67)
are having moderate mucositis. No patient is having severe level of mucositis.
Comparison of Overall Pre test and Post test level of mucositis
N=15
Aspects
Respondents level of mucositis
Pre test
Post test-2
Enhancement
Mean
19.067
11.467
7.6
SD
2.576
2.356
Paired ‘t’
Test
8.4304*
* Significant at 0.05 level,
The t-test value (t=8.4304) indicates that there is a significant difference (improvement) in the pre and post
intervention level of patient condition (oral mucositis).
DOI: 10.9790/1959-04134043
www.iosrjournals.org
42 | Page
A Study to determine the effectiveness of honey /frozen fruit juice/fresh fruit juice along with oral ….
Section - 2: GROUP III
Pre intervention Level of Mucositis
N=15
Level of Mucositis
Category
Mild
Moderate
Severe
Total
9 – 13
14 – 18
19 - 24
Respondents
Number
0
08
07
15
Percent
0
53.33
46.67
100.0
The above table indicates the pre-intervention level of mucositis in group 3 cancer patients before administering
frozen fruit juice (papaya). Most of the patients 8 (53.33) are having moderate mucositis and 7(46.67) are
having severe of mucositis.
Post intervention Level of Mucositis
N=15
Level of Mucositis
Category
Mild
Moderate
Severe
Total
9 – 13
14 – 18
19 - 24
Respondents
Number
12
3
0
15
Percent
80
20
0
100.0
The above table indicates the post-intervention (post test 2) level of mucositis in group 3 cancer patients after
administering frozen fruit juice (papaya). Most of the patients 12(80) are having mild mucositis and 3(20) are
having moderate mucositis. No patient is having severe level of mucositis.
Comparison of Overall Pre test and Post test level of mucositis
N=15
Aspects
Respondents level of mucositis
Pre test
Post test-2
Enhancement
Mean
18.467
11.2
7.267
SD
2.56
1.97
Paired ‘t’
Test
8.711 *
* Significant at 0.05 level,
The t-test value (t=8.711) indicates that there is a significant difference (improvement) in the pre and post
intervention level of patient condition (oral mucositis).
Comparison of the effectiveness of honey ,fresh fruit juice and frozen fruit juice in reducing oral mucositis
among group-I and group-II & group-III oncology clients. N=15
Aspects
Group 1
Group 2
Group 3
Respondents level of mucositis
Mean
SD
10.4
1.6818
11.467
2.3564
11.2
1.9712
F value
1.1304*
* Significant at 0.05 level,
The Chi Square value (1.1304) indicates that there is a significant difference in the extent of
improvement of oral mucosits in three experimental groups of cancer patients. The group for which Honey is
been administered shown better improvement than the other groups.
The level of mucositis of the first group after administering honey improved significantly compared to
the other two groups. With the above findings the researcher come to the conclusion that honey is more effective
in relieving oral mucositis compared to fresh fruit juice (papaya) and frozen fruit juice(papaya)
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DOI: 10.9790/1959-04134043
www.iosrjournals.org
43 | Page